For
those interested in HIFU as practised in Canada,
this link give some useful information.
There
are basically two approaches to HIFU - that denoted as Sonablate 500 and that
denoted Ablatherm. Both are claimed to be better than the other and so it might
be in your interests to read Transrectal
HIFU: The Next Generation? a solid paper published by PCRI Insights in 2004.
At
the top of this page it is said that the more experienced the team carrying out
any procedure, the less the likelihood of side effects. It has become clear from
a number of studies - like the
one discussed here that, unsurprisingly, it takes time and experience to learn
to carry out HIFU well, so if you are considering this option make sure that you
establish very clearly just how much good experience the team has got before committing
yourself. There is a useful
assessment of a British paper regarding outcomes.
You
can view a video clip on YouTube
if
that link is gone, search YouTube by putting prostate surgery in the Search engine
on site.
If
you are looking for specialist who can carry out the HIFU procedure, you may come
across this site - HIFU
- Physicians and Doctors Directory. Before using one of these doctors you
should read this
commentary on the site.
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additional information you need, you will almost certainly get a good response.
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This
therapy has many acronyms and names. Some are ADT, ADT2, ADT3, CHB, CHB2, CHB3,
CHT, HBT. Technically all refer to the main object - to control the body's production
or absorption of testosterone or, more precisely, dihydrotestosterone, commonly
referred to as DHT. Hormone therapy is sometimes described as a chemical orchidectomy
- the advantage is that it is reversible. Usually a combination of drugs is used
to prevent production of testosterone by the testicles and block the cancer tumour
from using the testosterone produced by the adrenals. This can reduce the size
of the tumour in about 80% of cases.
Historically,
hormone therapy was used primarily as a treatment of metastasised cancers or as
a salvage procedure for a failed treatment. However, it is now often used as a
primary treatment to reduce the size of the prostate prior to other treatment
- referred to as neo-adjuvant therapy - and sometimes after primary treatment,
such as radiation therapy, when it is referred to as adjuvant therapy. Some surgeons
will not operate on a prostate where this therapy has been used prior to surgery
as the treatment alters the cellular structure of the gland itself. As is the
case with most issues to do with prostate cancer, there is considerable disagreement
about when and how this therapy should be applied.
The
drugs used often have different names in different countries, but the most common
ones are: Lupron
(leuprolide acetate) and Trelstar
(triptorelin pamoate) which are both
injected intramuscularly into the buttock. Zoladex (goserelin acetate) is injected
subcutaneously into the lower abdomen.
Reported
side effects of hormone therapy are numerous but are usually, but not always,
reversible if the treatment is stopped - these side effects are sometimes referred
to as Androgen
Deprivation Syndrome, which results from lack of testosterone. One of the
most serious - and some say, inevitable - results of hormone
therapy is loss of bone mineral density
or osteoporosis, which can result in fractures and/or collapse of spinal vertebrae.
It can be treated/prevented IF the medic or his patient is aware of the
risk. Regrettably far too many people in the medical world seem to be ignorant
of the side effects of the drugs they prescribe, so the burden of tracking and
education devolves upon the patient.
The
principle side effects of of major concern to men are loss of libido and erectile
function - this therapy is often
referred to as "chemical castration" and men can and are labelled as
eunuchs. Although
little can be done about the effects of loss of libido and erectile function,
this piece -
Castrated, Emasculated, But Hardly Disempowered!
might be useful for men concerned about emotional aspects of these issues.
One
of the other annoying side effects - hot flushes - can be treated successfully,
although this seems not to be well-known among some inattentive medics. Three
options are:
1.
Depo
Provera (medroxyprogesterone, a synthetic form of the female hormone progesterone),
the "label" use of which is as a female contraceptive. In the 400 mg (contraceptive)
dosage, a study (Langstroer et al.J Urol. 2005 Aug;174(2):642-5,
Pub Med ID 16006929) has demonstrated excellent results in relief
of hot flushes among men on ADT (androgen deprivation therapy).
2.
Paxil (paroxetine hydrochloride), an antidepressant. A side effect is to relieve
hot flushes.
3.
Effexor (venlafaxine hydrochloride), an antidepressant. Same story.
4.
Megace
(megestrol acetate): has
been used successfully to relieve hot flushes, although some
concern has been expressed by one doctor that it might encourage PCa development
where the tumor has mutated. Unfortunately, there appears to be no way to be certain
whether this has occurred.
For
more on this option go to "Hormone
Therapy"
Recent
links of interest are: "Hormone
Therapy for Prostate Cancer"; and Androgen
Deprivation following Recurring Prostate Cancer
A
wonderful source of very detailed informationon
on this subject is A
Primer on Prostate Cancer. The Empowered Patients Guide by Donnna
Pogliano, a prostate cancer activist a book which she co-authored with Dr Strum
and which is . It is not an 'easy read' to glance through while lounging by the
pool, but it allows laypeople to get a good understanding of complex medical issues.
The ISBN number is 0-9658777-6-0 and it has been available at Amazon and Barnes
& Noble as well as at the Life Extension
Foundation site, whose support saw the book published.
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to know more?? Suggest
you post to the FORUM
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Treatment Choice you are interested in and what
additional information you need, you will almost certainly get a good response.
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This
procedure was pioneered in France but is now done in the United States and many
other countries. The surgery is carried out through three small incisions and
is done by a surgeon with the assistance of small robots. It is important to note
that robotic assistance does not reduce the difficulty associated with obese patients
and those with large prostates, middle lobes, or previous surgery, in whom outcomes
are less satisfactory than in patients without such factors.
The
main advantage claimed for this procedure is that recovery is quicker because
there are no large incisions to reach the prostate - just the relatively small
ones needed to get the equipment to the site. Of course there are still the side
effects of the surgery because the actual operation doesn't change - the nerves
needed for erection can still get damaged, the urethra still has to be cut and
re-attached to the bladder and so on. Some surgeons say they do not like the procedure
because they cannot feel the texture of the gland and that they need this to identify
more clearly where the tumour might be located (this is an important issue in
making decisions on nerve sparing). The surgeons who favour the procedure say
that they can see what they are doing much more clearly and are therefore better
able to make better incisions and joins.
Surgeons
who are skilled in the procedure produce good results, but there is a steep learning
curve. A number of studies have been published comparing short term outcomes between
the laparoscopic and open surgery, some of which appear to be biased in favour
of the traditional method because they do not compare surgeons of equal skill
and experience. One study, published in December
2009 by the Karolinska Institute in Sweden shows these results:
1,253 patients had a RALP (Robotic Assisted Laparoscopic Prostatectomy) and 485
had an RRP( Regular Radical Prostatectomy).
170 patients required blood transfusions of whom 112 (23 percent) underwent an
RRP and 58 (4.8 percent) underwent a RALP.
Infectious complications occurred in 44 RRP patients (9 percent) compared with
18 RALP patients (1 percent).
Bladder neck contractures was treated in 22 RRP patients (4.5 percent) compared
with 3 RALP patients (0.2 percent)
It
cannot be emphasisied enough that these results are those achieved by experienced
surgeons. It has been said that a surgeon needs to complete successfully
a minimum of 250 RALP procedures before being considered competent.
This
website
may be of assistance and interest and you can view
the procedure by clicking the link or by going to YouTube
if that link is gone, search YouTube by putting prostate surgery in the Search
engine on site. The National
Cancer Institute has a good explanation of the advantages and disadvantages
of the various surgical options. Another site to visit lists the hospitals and
doctors licenced to do the da Vinci
procedure.
The
Krongrad Institute has information about prostate
cancer diagnosis and prostate cancer treatment, with a special emphasis on laparoscopic
prostate cancer surgery. Also includes patient stories, opinion, and invited commentary.
John
Chandler says that he maintains what he regards as the best list of supposedly
good RP surgeons in the U.S. and Europe. He also maintain lists of U.S. specialists
in imaging, radiological oncology, and medical oncology and will e-mail these
lists to anyone requesting them. (Of course no guarantee is made concerning the
performance of any given physician.) Although there is much disagreement about
what the best treatment might be, there no doubt about the fact that the best
results come from the best operators, so it is worth contacting John.
Men
considering this option might find it helpful to review the
suggested list of items to assemble prior to surgery and
to visit Instructions
For Care Following Robotic Prostatectomy
and also Me and My Catheter..
Another
aspect of Surgery that often causes some concern ahead of the procedure is the
likely effect on sexual ability. There are five pieces that might be useful reading:
Sex
after Radical Prostatectomy
Sex
and Prostate Cancer
Erections - What Most Men
Won't Talk About but They All Want to Know About
Use
It or Lose It
Peyronies
Disease
Husband
and wife team Stephan Wilkinson and Susan Crandell contributed their views on
erectile dysfunction for the book Over
the Hill and Between the Sheets: Sex, Love and Lust in Middle Age after Stephan's
radical prostatectomy. These excellent pieces show clearly some of the differences
between the way men and women regard the issue and are well worth reading. Susan's
essay is What's Sex Got To Do With It? and Stephan's
is entitled Mechanical Failure. Sex therapist
Bettina Arndt collected data from a number of men on the site for her book What
Men Want - in bed is all about why sex matters so much to men
This
paper Nine Decisions Before
Electing RADIATION THERAPY After Radical Prostatectomy is intended to guide
decision making for so-called 'salvage therapy' in the event of primary therapy
such as surgery being diagnosed as having failed.
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Men
diagnosed with late stage prostate cancer may go into remission if their testicles
are removed. This is known as an orchidectomy or orchiectomy and is an effective
method of lowering the testosterone level. It is important to reduce the level
of testosterone as this is a major source of 'fuel' for the growing cancer. There
are few side effects, but there are many psychological reasons which deter men
from considering such an approach. A similar effect can be produced through the
use of Hormone Therapy , which is reversible, an orchidectomy
is not.
Ric
Masten is a poet. He had an orcidectomy. For his view of this, read his poem BILATERAL
ORCHIDECTOMY
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This
was regarded as an excellent alternative treatment and there were many reports
of excellent results, including from one of our members. Concerns were raised
however that the compound might rely on estrogen compounds and that these might
give rise to thrombosis. The compound did not have FDA approval and was heavily
criticised in The New England Journal of Medicine -- September 17, 1998 issue.
It was withdrawn from the market following action by the government of California
and was the subject of considerable litigation. There are other clones said to
be as effective as PC-Spes,
although none appear to be so, based on anecdotal evidence.
One
of the best known clones is a compound marketed as Prostasol.
There are said to be two versions of this - Dr Donsbach's which is apparently
made in Mexico and marketed mainly in the USA and another marketed in Europe.
The precise compound of Prostasol is unknown, the contents are not stated on the
packaging and may change from time to time. It also appears that there may be
signficant differences between the Mexican and European versions. The Danish Medicines
Agency published a warning
stating in part: "The description of the contents states that Prostasol
is a pure herbal product, but a Danish analysis shows that Prostasol contains
diethylstilbestrol (synthetic oestrogen)." There have been reports of
men suffering from thrombosis - see Venous
Thromboembolism as an example - and great care should be taken in using these
compounds, which should only be taken under medical supervision. It may be necessary
to use warfarin/coumadin to reduce the potential for blood clotting. Dr
Donsbach was arrested in April 2009, and charged with 11 felony counts including
treating patients without a license, misbranding drugs for sale, grand theft,
unlawfully dispensing drugs as a cure for cancer, and falsely representing a cure
for cancer.
Other
clones are marketed as PC-HOPE, PC-CARE and PC-PLUS. They are reviewed in a good
piece on CancerHelpUK
which concludes with this stern warning:
"Using these herbal products instead of conventional treatments for
prostate cancer could be very harmful to your health."
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you post to the FORUM
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Treatment Choice you are interested in and what
additional information you need, you will almost certainly get a good response.
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|
PHOTO
DYNAMIC THERAPY (PDT) |
Photodynamic
therapy (PDT) has been used to treat cancer for
more than 25 years. Although the focus has been primarily on surface or superficial
lesions, such as skin cancer, there has been a movement to find ways of treating
of deeper malignancies, such as prostate cancer. The way in which this therapy
works is that a photosensitizing drug is introduced. When this is irradiated by
light at a specific wavelength it generates an cell death, primarily through apoptosis,
micro vascular damage, and an anti-tumor immune response. In treating prostate
cancer infra-red light is used introduced to the gland by probes inserted through
the perineum in much the same way as Brachytherapy probes are dealt with. The
procedure has not been approved by the FDA for the treatment of prostate cancer,
but there is a growing body of evidence concerning its efficacy and the innate
minimally invasive characteristics of PDT suggest that it should become an important
addition to the growing array of techniques in interventional oncology.
An
excellent piece published in Nature Clinical Practice Urology in early 2009 is
Photodynamic
therapy for prostate cancer—a review of current status and future promise
. It is a fairly technical article and it might be better to read the summary
from the Link above before moving to this article. This paragraph extracted from
the article sums up the conclusions of the article:
The
benefits of prostate cancer treatment depend upon eradication of cancer within
the gland, while the harms of treatment are related to unwanted effects outside
the gland. When treatment is limited to either the prostate gland itself, or the
areas of cancer within the gland where possible, then there is the potential to
achieve the survival benefits of radical treatments in those men who require it,
while avoiding the associated adverse effects. Such an approach would have to
eradicate clinically relevant cancer, while at the same time leave the structures
that surround the prostate (including the rhabdosphincter, rectum, neurovascular
bundles and ejaculatory apparatus) intact. Eventually, a systemic but targeted
therapy will likely meet these requirements; however, as no obvious compound with
these attributes is currently in clinical studies, it is fair to assume that we
are at least a decade away from such a treatment becoming a reality.
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This
form of radiation therapy has not been as widely used for prostate cancer as some
of the other forms of therapy. It uses atomic particles which deposit most of
their energy at the end of their travel. It is claimed that they can be delivered
more selectively, that damage to surrounding healthy tissue is reduced and that
there are likely to be fewer side effects than EBR. Long
term data is becoming available, although much of that is generated by the
treatment centres. One independent study Proton
Therapy in Clinical Practice: Current Clinical Evidence concluded, as far
as Prostate Cancer treatment was concerned:
